RAP schedule forms

Last updated:

Here you can find the forms you may need to prescribe an item under the Rehabilitation Appliances Program (RAP).

Forms

Forms are listed in alphabetical order. Guidelines are available to help you prescribe certain items.

Assistance dog — for psychiatric, guide, hearing and mobility dogs

See our guidelines page for more information on how to prescribe an assistance dog

Assistive listening devices

See our guidelines page for more information on how to prescribe assistive listening devices

Communication devices

See our guidelines page for more information on how to prescribe communication devices

Continence

See our guidelines page for more information on how to prescribe continence products

Diabetes 

See our guidelines page for more information on how to prescribe diabetes products.

Electric mobility aids

See our guidelines page for more information on how to prescribe electric mobility aids

Essential medical equipment

Apply for an annual payment to help with the energy costs of essential medical equipment

Home modifications

See our guidelines page and our Resources for assessing health providers for more information on how to prescribe home modifications

Low vision products (CCTV)

See our guidelines page for more information on how to prescribe CCTV

Mobility & functional support

See our guidelines page for more information on how to prescribe recliner chairs and adjustable electric beds

Non-nutritional thickened fluids

Oxygen and breathing support

For more information on how to prescribe see our guidelines:

Personal response system (PRS)

See our guidelines page for more information on how to prescribe PRS

Request / referral for LMO use

Trial of equipment (exercise bike/knee scooter) - 3 months only

Vehicle modifications

See our guidelines page for more information on how to prescribe vehicle modifications

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